 Hello everyone, today we are talking about hemoglobin A1c. A few things you really need to know because if you don't know these things you will be totally misled about A1c. So you better know these facts today in this video that's gonna only take a few minutes. So remember to subscribe, give a thumbs up and share this video if you like this and remember knowledge is the power. I'm Dr. Ahmad Ergan. I'm an endocrinologist and a diabetes expert and today we're talking about hemoglobin A1c. So guys remember to take the quiz make sure you watch the entire video you will win a chapter from my diabetes book. You may win any chapter from my diabetes book. It could be a chapter 1, chapter 2, chapter 5. So if you keep taking these quizzes you're gonna end up winning the entire book which is a $25 value for you. So let's get started. So guys if you watched my previous A1c videos just like this one or that one or this one we make A1c videos. Why? Because A1c is the most important test in diabetes and that is the test that you always discuss with your doctor. So when the doctor says to you your A1c is 9% and you're like, okay, so what because you don't know what it is, right? Or your doctor says your A1c is 7% and you're like, yeah, I'm down to 7%. I'm like, okay, so what are you happy about? They're like, I don't know. From 9 to 7, sounds good to me. Well, you better know a little bit more. Now, as you all know, the A1c is an average blood sugar. It's a percentage. We look at the hemoglobins, how sticky, how sugar loaded your hemoglobins are. Now what's hemoglobin? Well, hemoglobin is the basic molecule in your red blood cells that carry the oxygen. And when they're stuck with too much glucose, we call them glycated, we can tell how high your blood sugar is. We have a mathematical calculation about your average blood sugar. So it's just a scientific thing. So the thing is, now if you're, for example, your average blood sugar is 150, your A1c is around 7%. So here's the deal. If your doctor says your A1c is 7%, but your blood sugar is running in the 200s, you should ask yourself, is that really good? Or is my A1c correct? So what's wrong? Because I know as a patient, because I am an educated patient doctor, you better know your patient. So I am educated because I know that A1c may not be right. Or it may be the other way around. Your doctor may say that your A1c is like 9%, but your blood sugars are in the low 100s, 80s, 90s, it never goes up. You can be like, Doc, what are you talking about? You know, my A1c is, it doesn't make any sense because my blood sugars are so good in my fingers. So which one is incorrect? Is it your finger sticks are incorrect? Is your A1c incorrect? Well, here is how to find out. Look at your CBC, okay? So CBC shows your blood count. In that blood count, you have to look at your hemoglobin. It's generally abbreviated as HB. Or hematocrit, abbreviated as HCT sometimes. If your hemoglobin and hematocrit is off the chart, you know you have a problem, right? Certain ethnicities also may have a carrier status of certain disorders like blood disorders like thalassemia for Mediterranean descent, skill cell anemia for African American descent. Sometimes they are carriers and they have some abnormality in their hemoglobin variants because we have different variants of hemoglobin in our blood. And we assume when we do a test, we just assume that you're just normal like everybody else, but you may not be that normal person. You may not even know. Also, if you're anemic, for example, if your hemoglobin is down to 10 or 11, that makes a huge difference. If you are treated versus untreated anemia, that also makes a huge difference. So what difference does it make? So if you are anemic, right? So your body is not really making new cells, new red blood cells, new hemoglobin. So your majority of your red blood cells are full of the old ones. Now what happens when you get old? You carry a lot of stuff. You accumulate a lot of stuff. Same thing with the red blood cells. They accumulate a lot of red blood cells. And when there is no youngsters coming in, it looks like, you know, your hemoglobin is very high in a false way. Now what happens when you get treated? Let's say you're iron deficient, you're B12 deficient, and you start treating this, and then suddenly your body starts making all these young red blood cells, and suddenly your blood is full of youngsters. Now they don't carry the glucose because again, we are measuring the average of three months. And then when we sample your blood, and if you sample a bunch of youngsters hemoglobin instead of the older ones, not a good mix, then we are going to be misled thinking that your hemoglobin A1C is good, but actually it is not because, you know, all these young red blood cells are not exposed to glucose. So we are assuming when we test you that you have a regular 120 days cycle of every red blood cell. But again, if you're anemic and your cells do not have an average of 120 days, then you will have falsely high or falsely low numbers. So if that's the case, you always question and discuss with your doctor, hemoglobin A1C may not be the best test for you if that is the case. So what are the other tests? Well, there are other tests you can use after discussing with your doctor, such as fructosamine, such as glycomarque, and there's some other like tests that are out there depending on the country you're in. But the in the United States we mostly use fructosamine and glycomarque. Glycomarque test you cannot use if you're on SGLT2 inhibitor, such as Jardins, Farsiga, or in Makaya type of drug. But fructosamine can show your last two to three week blood sugar spikes, and that may be helpful as well. I know a lot of insurance companies are judging you or your doctor or your doctor is judging everybody, judging everybody, right? You should have a quotation or notation in your chart saying that this patient's A1C is not valid because of this, this, and this. So I hope this was helpful guys. Remember to take the quiz and listen to the description below. Check it out and we will see you in the next video. And before that give a thumbs up, share, and like this video guys. Talk to you later. Hey guys, I hope you're enjoying this channel so far and I hope you're subscribed already. If you didn't do it, and if you did watch this video right there, I think that will help you too.